Individual provider Active NPI

Tiffany P. Le Endo, D.O.

  • Family Medicine Physician
  • La Verne, CA
National Provider Identifier
1457384257
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A7282 Issued in CA
Practice address
2333 Foothill Blvd Ste B
La Verne, CA 91750-3027
Phone
(909) 392-6501
Fax
(909) 469-2136
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A7282 CA Primary

Addresses

Primary practice location

2333 Foothill Blvd Ste B
La Verne, CA 91750-3027

Mailing address

2333 Foothill Blvd Ste B
La Verne, CA 91750-3027
Phone (909) 392-6501

Other identifiers 1

IdentifierTypeStateIssuer
1453844257MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031203000276 CA Practitioner - Family Practice 8628972122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1997
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1770 N Orange Grove Ave
Suite 101
Pomona, CA 91767-3027
Phone (909) 469-9494

2333 Foothill Blvd
La Verne, CA 91750-3027
Phone (909) 392-6501

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A7282CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Family Medicine Associates, Inc Family Medicine CurrentSince Oct 1, 2017 Accepting new patients
Premier Family Medicine Associates, Inc Family Medicine CurrentSince Oct 1, 2017 Accepting new patients
Premier Family Medicine Associates, Inc Family Medicine Current Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Premier Family Medicine Associates, Inc Family Medicine Past Accepting new patients

Locations

2140 Grand Ave
Ste 125
Chino Hills, CA 91709
Phone (909) 630-7875

2333 Foothill Blvd
Ste B
La Verne, CA 91750
Phone (909) 392-6501

1770 N Orange Grove Ave
Ste 101
Pomona, CA 91767

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1457384257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 FOOTHILL BLVD STE B",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503027",
            "telephone_number": "909-392-6501",
            "fax_number": "909-469-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 FOOTHILL BLVD STE B",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503027",
            "telephone_number": "909-392-6501",
            "fax_number": "909-469-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDO",
        "first_name": "TIFFANY",
        "middle_name": "P. LE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A7282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1453844257",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Verne, CA

Sources for this page

Verify at the official NPI Registry.